Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.727
Index Copernicus  – 166.39
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 8, August, p. 1117–1123

doi: 10.17219/acem/75604

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Nutritional assessment of patients with end-stage renal disease using the MNA scale

Łukasz Rogowski1,A,B,C,D, Mariusz Kusztal2,C,E, Tomasz Gołębiowski2,B,C, Katarzyna Bulińska3,B,C, Agnieszka Zembroń-Łacny4,E, Joanna Wyka5,E, Marian Klinger2,E,F, Marek Woźniewski3,E,F, Wioletta Dziubek3,C,D,E,F

1 Nonpublic Medical College, Wrocław, Poland

2 Department and Clinic of Nephrology and Transplantation Medicine, Faculty of Medicine, Wroclaw Medical University, Poland

3 Department of Physiotherapy, University School of Physical Education, Wrocław, Poland

4 Faculty of Medicine and Health Sciences, University of Zielona Góra, Poland

5 Department of Human Nutrition, Faculty of Food Science, University of Environmental and Life Sciences, Wrocław, Poland


Background. Patient malnutrition is a significant problem in the process of rehabilitation and treatment. One of the tools that can reveal the risk of malnutrition is a series of standardized nutritional questionnaires.
Objectives. The aim of the study was to assess the nutritional status of patients with end-stage renal disease (ESRD) by means of the minimal nutritional assessment (MNA) scale.
Material and Methods. The study group included respondents suffering from ESRD who were patients of the Dialysis Center at the Clinic of Nephrology and Transplantation Medicine at the University Clinical Hospital in Wrocław. The study was conducted in 47 dialysis patients (22 women and 25 men), mean age 69.68 ±8.95 years. A standardized MNA scale was used to evaluate the nutritional status of the patients.
Results. In the study group, women had a significantly lower score on the MNA scale than men (23.95 vs 25.26 points). Using the MNA scale, the risk of malnutrition was found in 13 patients, while malnutrition was found in 1 patient. Among females, the mean body mass index (BMI) was 27.28, and it was significantly correlated with the MNA score. In males, the mean BMI was 29.61, but it did not correlate with the MNA score. The time spent undergoing renal replacement therapy was 7.63 years for women and 7.24 years for men. This correlated significantly with the MNA score only in the case of men. Significant correlations were established between eating habits and MNA scores in both groups.
Conclusion. The results obtained using the MNA scale showed a significant risk of malnutrition in patients with ESRD. In women only, a low score on the MNA scale significantly correlated with the BMI. The time of renal replacement therapy had a significant impact on the MNA scale only in the case of men. An influence of comorbidities on the MNA scores recorded by men and women was not observed. Major health incidents and other stressful situations significantly affected the nutritional status in men.

Key words

nutritional status, chronic kidney failure, hemodialysis patients, minimal nutritional assessment

References (35)

  1. Zhang QL, Rothenbacher D. Prevalence of chronic kidney disease in population-based studies: Systematic review. BMC Public Health. 2008;8:117.
  2. Lysaght MJ. Maintenance dialysis population dynamics: Current trends and long-term implications. J Am Soc Nephrol. 2002;13 (Suppl 1):37–40.
  3. Król E, Rutkowski B. Przewlekła choroba nerek: Klasyfikacja, epidemiologia i diagnostyka. Forum Nefrologiczne. 2008;1:1–6.
  4. Jadeja YP, Kher V. Protein energy wasting in chronic kidney disease: An update with focus on nutritional interventions to improve outcomes. Indian J Endocrinol Metab. 2012;16(2):246–251.
  5. Bonanni A, Mannucci I, Verzola D, et al. Protein-energy wasting and mortality in chronic kidney disease. Int J Environ Res Public Health. 2011;8(5):1631–1654.
  6. Kovesdy CP, Kalantar-Zadeh K. Why is protein-energy wasting associated with mortality in chronic kidney disease? Semin Nephrol. 2009;29(1):3–14.
  7. Modification of Diet in Renal Disease Study Group. The modification of diet in renal disease study: Design, methods and results from the feasibility study. Am J Kidney Dis. 1992;20(1):18–33.
  8. Lowrie EG, Lew NL. Death risk in hemodialysis patients: The predictive value of commonly measured variables and an evaluation of death rate differences between facilities. Am J Kidney Dis. 1990;15(5):458–482.
  9. Peev V, Nayer A, Contreras G. Dyslipidemia, malnutrition, inflammation, cardiovascular disease and mortality in chronic kidney disease. Curr Opin Lipidol. 2014;25(1):54–60.
  10. Toigo G, Aparicio M, Attman P, et al. Expert Working Group report on nutrition in adult patients with renal insufficiency (part 1 of 2). Clin Nutr. 2000;19(3):197–207.
  11. Ikizler TA, Hakim RM. Nutrition in end-stage renal disease. Kidney Int. 1996;50(2):343–357.
  12. Leavey SF, Strawderman RL, Jones CA, Port FK, Held PJ. Simple nutritional indicators as independent predictors of mortality in hemodialysis patients. Am J Kidney Dis. 1998;31(6):997–1006.
  13. Jiang MY, Hwang JC, Lu YH, Wang CT. Clinical implications and outcome prediction in chronic hemodialysis patients with lower serum potassium×uric acid product. Eur J Intern Med. 2015;26(8):646–651.
  14. Qureshi AR, Alvestrand A, Danielsson A, et al. Factors predicting malnutrition in hemodialysis patients: A cross-sectional study. Kidney Int. 1998;53(3):773–782.
  15. Lynch KE, Lynch R, Curhan GC, Brunelli SM. Altered taste perception and nutritional status among hemodialysis patients. J Ren Nutr. 2013;23(4):288–295.
  16. Kraut JA, Kurtz I. Metabolic acidosis of CKD: Diagnosis, clinical characteristics, and treatment. Am J Kidney Dis. 2005;45(6):978–993.
  17. Ikizler TA, Pupim LB, Brouillette JR, et al. Hemodialysis stimulates muscle and whole body protein loss and alters substrate oxidation. Am J Physiol Endocrinol Metab. 2002;282(1):E107–116.
  18. Stenvinkel P, Heimbürger O, Lindholm B, Kaysen GA, Bergström J. Are there two types of malnutrition in chronic renal failure? Evidence for relationships between malnutrition, infla mmation and atherosclerosis (MIA syndrome). Nephrol Dial Transplant. 2000;15(7):953–960.
  19. Kraut JA, Madias NE. Metabolic acidosis of CKD: An update. Am J Kidney Dis. 2016;67(2):307–317.
  20. Movilli E, Bossini N, Viola BF, et al. Evidence for an independent role of metabolic acidosis on nutritional status in hemodialysis patients. Nephrol Dial Transplant. 1998;13:674–678.
  21. Ballmer PE, McNurlan MA, Hulter HN, Anderson SE, Garlick PJ, Krapf R. Chronic metabolic acidosis decreases albumin synthesis and induces negative nitrogen balance in humans. J Clin Invest. 1995;95(1):39–45.
  22. Fouque D, Laville M. Low protein diets for chronic kidney disease in non-diabetic adults. Cochrane Database Syst Rev. 2009;8(3):6–8.
  23. Green SM, Watson R. Nutritional screening and assessment tools for older adults: Literature review. J Adv Nurs. 2006;54(4):477–490.
  24. Guigoz Y. The Mini Nutritional Assessment (MNA) review of the literature: What does it tell us? J Nutr Health Aging. 2006;10(6):466–485.
  25. Vellas B, Guigoz Y, Garry PJ, et al. The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition. 1999;15(2):116–122.
  26. Burman M, Säätelä S, Carlsson M, Olofsson B, Gustafson Y, Hörnsten C. Body mass index, mini nutritional assessment, and their association with five-year mortality in very old people. J Nutr Health Aging. 2015;19:461–467.
  27. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003;22:415–421.
  28. Koor BE, Nakhaie MR, Babaie S. Nutritional assessment and its correlation with anthropometric measurements in hemodialysis patients. Saudi J Kidney Dis Transpl. 2015;26(4):697–701.
  29. Steiber A, Leon JB, Secker D, et al. Multicenter study of the validity and reliability of subjective global assessment in the hemodialysis population. J Ren Nutr. 2007;17(5):336–342.
  30. Tan SK, Loh YH, Choong LH, Suhail SM. Subjective global assessment for nutritional assessment of hospitalized patients requiring hemodialysis: A prospective cohort study. Nephrology (Carlton). 2016;21(11):944–949.
  31. Santin FG, Bigogno FG, Dias Rodrigues JC, Cuppari L, Avesani CM. Concurrent and predictive validity of composite methods to assess nutritional status in older adults on hemodialysis. J Ren Nutr. 2016;26(1):18–25.
  32. Tsai AC, Wang JY, Chang TL, Li TY. A comparison of the full Mini Nutritional Assessment, short-form Mini Nutritional Assessment, and Subjective Global Assessment to predict the risk of protein-energy malnutrition in patients on peritoneal dialysis: A cross-sectional study. Int J Nurs Stud. 2013;50(1):83–89.
  33. Segall L, Mardare NG, Ungureanu S, et al. Nutritional status evaluation and survival in hemodialysis patients in one center from Romania. Nephrol Dial Transplant. 2009;24(8):2536–2540.
  34. Ladhani M, Craig JC, Irving M, Clayton PA, Wong G. Obesity and the risk of cardiovascular and all-cause mortality in chronic kidney disease: A systematic review and meta-analysis. Nephrol Dial Transplant. 2017;32(3):439–449.
  35. Brzosko S, Hryszko T, Kłopotowski M, Myśliwiec M. Validation of Mini Nutritional Assessment scale in peritoneal dialysis patients. Arch Med Sci. 2013;9(4):669–676.